TL;DR
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In a randomized trial of 453 adults aged 65 and older with advanced chronic kidney disease, a video decision aid paired with patient-recorded statements was linked to higher rates of advance care planning documentation at 12 months. The study did not establish whether the additional documentation led to care that matched patients’ preferences.
A video decision aid paired with patient-recorded statements was associated with more advance care planning documentation among adults aged 65 and older with advanced chronic kidney disease, according to a 12-clinic randomized trial published in JAMA Internal Medicine. At 12 months, records showed advance care planning documentation for 56.6% of participants offered the aid, compared with 40.0% receiving usual care.
The trial enrolled 453 adults with advanced kidney disease: 228 were assigned to the intervention and 225 to usual medical care. Participants in the intervention group watched a certified video presenting three treatment options for advanced CKD, then recorded a video statement about their goals, values and treatment preferences. That statement was sent to their treating clinician.
At the 12-month measurement, documentation of discussions about treatment options for kidney failure was also more common in the intervention group: 46.1%, compared with 31.6% in the control group. The researchers reported that after viewing the video, 13.2% of intervention participants were undecided about treatment, compared with 41.3% of controls. Conservative kidney management was the preferred option for 50.7% of the intervention group and 31.8% of the control group.
The study was led by Angelo E. Volandes of Dartmouth Health and colleagues. It was published in JAMA Internal Medicine to coincide with Kidney Week, the American Society of Nephrology’s annual meeting, held Oct. 21-25 in Denver. The study’s measured outcomes included preferences and documentation; it did not report whether participants ultimately received care matching those preferences.
Planning Before Kidney Failure Treatment
Advanced kidney disease can involve decisions about treatment options as illness progresses. The trial suggests a structured video, followed by a patient-authored statement, may help patients and clinicians record preferences and discuss options. The difference in documentation matters because a preference that is not recorded may be harder for care teams to identify later, although the trial did not test that consequence directly.
The results also show a shift in how participants expressed their choices: fewer were undecided after the video, while more selected conservative kidney management. That does not establish that one treatment approach is better, or that patients should choose a particular option. Instead, it indicates that the aid was associated with clearer stated preferences in this study. Whether those preferences were maintained over time or translated into care remains unknown.
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How the Trial Compared Care
Advance care planning involves discussing and documenting a person’s goals and treatment preferences in preparation for future health decisions. In this study, the intervention combined standardized educational video with a recording in which the patient described personal priorities. The control group received usual medical care, allowing the researchers to compare the added approach with routine care across 12 ambulatory clinics.
The report identifies the work as a multicenter, parallel-group randomized clinical trial. The article was published in JAMA Internal Medicine in 2026; its citation lists DOI 10.1001/jamainternmed.2026.5989. The source describes the trial population as older adults with advanced CKD, so the findings should not automatically be applied to younger people, patients with earlier-stage disease or other care settings.
““While further research is needed to determine whether increased documentation translates into goal-concordant care, these findings suggest that standardized education paired with patient-authored statements of preferences is a feasible addition to routine CKD care.””
— Angelo E. Volandes and colleagues, the study authors
Whether Preferences Shape Later Care
The findings establish a difference in documented planning and stated preferences, but the report does not show whether participants later received treatment consistent with their choices. It also does not provide details here on the duration of any effect beyond the 12-month assessment, or whether preferences changed as participants’ health changed.
The reported results do not specify how the intervention performed across different patient groups or clinics, nor do they establish how easily the approach could be adopted in other health systems. The authors say further research is needed to determine whether greater documentation leads to goal-concordant care. The figures should therefore be read as trial outcomes, not as proof that the video itself caused better health outcomes.
Testing Whether Planning Changes Care
The next research question is whether higher rates of recorded preferences lead to care that aligns with patients’ goals as kidney disease progresses. Further studies could track whether clinicians use the statements when discussing treatment and making decisions, and whether preferences remain current over time.
The authors describe the approach as a feasible addition to routine CKD care, but the report does not announce a rollout or identify a next trial. For now, the published results support the narrower conclusion that the combined video-and-recording intervention was associated with more advance care planning documentation at 12 months in this study population.
Key Questions
What did the video decision aid include?
It presented three treatment options for advanced chronic kidney disease. Participants then recorded their goals, values and treatment preferences for their clinician.
How many people took part in the trial?
The trial included 453 adults aged 65 and older with advanced CKD: 228 in the intervention group and 225 receiving usual care.
How much higher was advance care planning documentation?
At 12 months, documentation was recorded for 56.6% of the intervention group and 40.0% of the control group. These are the study’s reported rates; they do not by themselves show whether care later matched patients’ preferences.
Did the study show that patients received care matching their goals?
No. The report found higher documentation and differences in stated preferences, but whether those changes produced goal-concordant care remains untested in the findings described.
Source: medicalxpress.com
